Comparative study between excision with primary closure versus Limberg flap for treatment of primary sacrococcygeal pilonidal sinus

Background: Surgical treatment of sacrococcygeal pilonidal sinus is associated with significant recurrence rate. However; recent study suggested the use of rhomboid excision and Limberg flap repair as feasible procedure for treatment of pilonidal sinus disease. Our aim is to evaluate the role of rhomboid excision of the pilonidal sinus with Limberg flap by comparing this procedure with the traditional excision and primary closure.Methods: This prospective study included 60 patients with sacrococcygeal pilonidal sinus. The patients were randomly divided into 2 equal groups. Rhomboid excision of the sinus with limberg flap was performed in 30 patients (group A), and excision of the sinus with primary closure was done to the other 30 cases (group B). Demographic data and surgical outcome were compared between both groups.Results: Group A showed significant early retained to work and significant less postoperative pain than group B (P=0.04 and P=0.02 respectively). Incidence of wound dehiscence, postoperative hematoma and seroma was less among group A but without significant difference. The incidence of postoperative infection and recurrence rate was significantly less in group A than group B (P=0.04 and P= 0.035 respectively).Conclusions: Rhomboid excision and Limberg flap repair is an advantageous and effective modality than simple excision with primary closure in treatment of sacrococcygeal disease. In addition, it is safe and easily procedure; it may be an ideal treatment option in management of pilonidal sinus.

Download Full-text

Compare outcome of simple excision with primary closure vs rhomboid excision with limberg flap for pilonidal sinus

10.53350/pjmhs2115112920 ◽

2021 ◽

pp. 2920-2922

Author(s):

M. Kaleem ◽

F. Mubarik ◽

M. U. Afzal ◽

A. Zahid ◽

W. I. Andrabi ◽

...

Keyword(s):

Pilonidal Sinus ◽

Primary Closure ◽

Advancement Flap ◽

Pilonidal Sinus Disease ◽

P Value ◽

Limberg Flap ◽

Simple Excision ◽

Group A ◽

Group B ◽

Rhomboid Excision

Background: Sacrococcygeal pilonidal sinus is a common condition usually affecting young-to-middle-aged men. For managing sacrococcygeal pilonidal illness, a variety of lateralizing surgical flap procedures based on this principle have been published, including the Karydakis flap, Limberg flap, modified Limberg flap, Z-plasty, and Y-V advancement flap. Aim: To compare the outcome of simple excision with primary closure versus rhomboid excision with limberg flap for sacrococcygeal pilonidal sinus. Methodology: Randomized control study conducted in Surgery Department, Ghurki Trust Hospital, Lahore. 90 patients fulfilling the inclusion criteria were selected from wards and were randomly divided in two equal groups. In group A, patients underwent rhomboid excision with limberg flap. In group B, patients underwent simple excision with primary closure. The operation was performed under spinal anesthesia. After surgery, patients were evaluated every 24 hours if they are able to move on their own then they were discharged and hospital stay was noted. Then after 10 days, patients will be called in OPD for assessment of wound healing. If wound did heal and patient complained of pain (VAS>4) and cannot sit and have fever (temp>100oF) Results: The average age in group A was 44.37±15.42 years while that in group B was 45.24±14.50 years. In group A there were 23(51.1%) males and 22 (48.9%) females whereas in group B there were 25(55.6%) males and 20(44.4%) females. There was difference significant in the mean stay in hospital in both groups (p-value=0.002). Conclusion: The conclusion of the study, that primary sacrococcygeal pilonidal sinus disease and rhomboid excision with Limberg's flap is an effective treatment. Keywords: Simple Excision with Primary Closure, Rhomboid Excision, Limberg Flap, Sacrococcygeal Pilonidal Sinus

Download Full-text

Limberg flap versus primary closure in the treatment of pilonidal sinus: a randomised clinical study

International Surgery Journal ◽

10.18203/2349-2902.isj20213134 ◽

2021 ◽

Vol 8 (8) ◽

pp. 2388

Author(s):

Devaprashanth M. ◽

Srinivas N. M. ◽

Akhihlandeshwari N.

Keyword(s):

Clinical Study ◽

Pilonidal Sinus ◽

Primary Closure ◽

Wound Dehiscence ◽

Pilonidal Sinus Disease ◽

Limberg Flap ◽

Randomized Clinical Study ◽

Routine Work ◽

Group A ◽

Group B

Background: Pilonidal sinus is a chronic disease usually involving the sacrococcygeal area. Various treatment modalities exist, yet few comparison studies exist to compare the efficacy of one modality over the other. Hence this randomized clinical study was undertaken as an attempt to compare the outcomes of pilonidal sinus following Limberg flap procedure and primary closure.Methods: 60 patients undergoing surgery for pilonidal sinus disease were considered for the study. 30 patients underwent excision and primary closure and 30 patients underwent Limberg flap repair. They were followed up for 1 year. Duration of hospital stay, duration of inability to work, postoperative infection, wound dehiscence, and postoperative recurrence in a follow up period were recorded. Descriptive statistics, chi- square tests and independent t-test are the statistical tools employed.Results: Mean age was 29.83±4.99 years. Male:female ratio was 5.66:1. The mean duration of hospitalization in group A was significantly less (p<0.05) than group B. The patients in group B returned early to routine work (21.56±3.92 days) as compared to 30.5±5.92 days in group A (p<0.05). 5 of 30 patients in group A and 2 of 30 in group B developed surgical site infection. (p>0.05. 4 patients developed wound dehiscence in group A only which was found to be statistically significant.Conclusions: Limberg flap in treatment of pilonidal sinus is associated with shorter hospitalization, early return to routine work and less wound dehiscence as compared with excision and primary closure. Wound infections are comparable with both the modalities.

Download Full-text

PILONIDAL SINUS DISEASE: COMPARISON OF EXCISION AND PRIMARY CLOSURE VERSES EXCISION AND HEALING BY SECONDARY INTENTION

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2012.2.1.134-137 ◽

1969 ◽

Vol 2 (1) ◽

pp. 134-137

Author(s):

Mohammad Hussain ◽

Manzoor Ali ◽

S.M.Naeem ◽

Nisar Ali ◽

Muhammad Ismail

Keyword(s):

Local Excision ◽

Pilonidal Sinus ◽

Wide Local Excision ◽

Primary Closure ◽

Health Concern ◽

Pilonidal Sinus Disease ◽

Sinus Disease ◽

Secondary Intention ◽

Group A ◽

Group B

Introduction: Sacrococcygeal pilonidal disease is a serious health concern because of its associatedcomplications and recurrence. Pilonidal sinus disease is presented with symptoms ranging fromasymptomatic pits to painful draining lesions that are predominantly located in the sacrococcygeal region. Itis characterized by multiple subcutaneous sinuses, containing hairs. The exact etiology of the disease is notknown. Various treatment options are available. The choice of a particular surgical approach depends on thesurgeon's familiarity with the procedure and perceived results. The present study was aimed to compare twotreatment regimens i.e.excision and primary closure verses excision and healing by secondary intention.Patients and methods: The study was conducted in the department of surgery, Saidu Teaching HospitalSaidu Sharif Swat. Forty nine (49) human subjects with informed consent were included in the study.Patients were divided in two groups, depending on their preference and acceptance of the procedure.Patients in group A under went excision of the tract with primary closure of the defect by primary simpleclosure, Rhomboid Limberg flap or by Karydakis procedure. Patients in group B were those in whom sinustracts were excised and wound was left open for healing by secondary intention.Results: Out of the total 49 patients 3 (6.122%) were female. Mean age was 26 years (range 18-40years).Group A comprised of 24 patients in whom wide local excision was performed and wound was closedprimarily while Group B comprised of 25 patients who underwent wide local excision and wound was leftopen for healing by secondary intention. Mean hospital stay of patients in group B was significantly longerthan group A (p=0.002). The mean time for complete healing of the wound after primary closure wasmarkedly shorter.mConclusion: Primary closure of the wound after excision of the sinus tract is preferable over simple excisionand healing by secondary intention.Key words; Pilonidal sinus, primary closure, simple excision.

Download Full-text

Comparison of two Different Surgical Modalities in the treatment of Pilonidal Sinus (Primary Closure and Open Technique)

10.53350/pjmhs2115112999 ◽

2021 ◽

Vol 15 (11) ◽

pp. 2999-3001

Author(s):

Muhammad Aamir Jamil ◽

Muhammad Imran Anwar ◽

Muhammad Waqas Saleem ◽

Sameen Tahir ◽

Haroon Javaid Majid

Keyword(s):

Pilonidal Sinus ◽

Primary Closure ◽

Pilonidal Sinus Disease ◽

Open Technique ◽

Sinus Disease ◽

Closed Technique ◽

Secondary Intention ◽

Group A ◽

The Mean ◽

Group B

Background: Pilonidal sinus is disease of young age andits prevalence is higher in men compared to women (almost twice).It is a disease that arises from hair follicles particularly present in the natal cleft. It occurs commonly in Jeep Drivers and hence gets the name from there “Jeep Drivers Disease” and also commonly occurs in Barbers. It leads to formation of abscesses and chronic wounds with discharge and pain. Disease can have huge impact on social life and quality of life. In most cases the treatment is incision and drainage. Study design: It is a case series study. Place and duration of study: Department of General Surgery at Shaikh Zayed Hospital Lahore from January 2019 to January 2021. Aim: To compare the relative effects of open and closed surgical techniques on the recurrence rate, rate of infection and time of healing for pilonidal sinus. Methodology: Patients with pilonidal sinus disease from January 2019 to January 2021 received surgical treatment either excision followed by primary closure as in closed technique (group A) or excision followed by leaving the wound open for healing by secondary intention as in open technique (group B). Surgical management is widely based upon two techniques open and closed. In open technique wound is left open and heals by secondary intention while in closed technique it is closed primarily and heals by primary intention. The better choice between these two techniques is still a topic of debate. Results: The most common age group for pilonidal sinus was between 16-25 years of age. The mean age came out to be 26.7 years. The mean healing time was 15 days in group A and 42 days in group B. The duration of hospital stay ranged between 2-8 days for group A and 5-16 days for group B. Early postoperative complications seen was infection in 1 patient (7.69%) in group A and 5 patients (35.71%) in group B and these cases were managed conservatively.1 (7.69%) case of aseptic gaping of wound after stitch removal was seen in group A and was managed with closed technique. Recurrences reported in group A was 1 case (7.69%) at 6 months and was surgically managed by open technique. There were a total of 4 (28.57%) recurrences which were left open to heal by granulation. Conclusion: It is concluded that better management option for pilonidal sinus disease is primary closure of defect. So it is suggested that management of pilonidal sinus disease should be individualized but preference must be given to closure of wound after excision. Keywords: Pilonidal sinus, Primary Closure, Open Technique.

Download Full-text

Assessment of the effect of platelet rich plasma on the healing of operated sacrococcygeal pilonidal sinus by lay-open technique: a randomized clinical trial

BMC Surgery ◽

10.1186/s12893-020-00865-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Mohamed M. Gohar ◽

Reda F. Ali ◽

Khaled A. Ismail ◽

Taha A. Ismail ◽

Nahla A. Nosair

Keyword(s):

Pilonidal Sinus ◽

Platelet Rich Plasma ◽

Trial Registration ◽

University Hospital ◽

Pilonidal Sinus Disease ◽

Open Method ◽

Early Return ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background Sacrococcygeal pilonidal sinus disease (PSD) is an infection of the skin and subcutaneous tissue at the upper part of the natal cleft of the buttocks. Excision and healing by granulation “lay-open” method is still more preferable than other methods of midline closure or using flaps but the healing time is lengthy. The present study was performed to assess the healing promotion effect of platelet-rich plasma (PRP) on the pilonidal sinus wounds treated by the lay-open method. Methods One hundred patients suffering from PSD were randomly divided into two groups, they were treated by the lay-open method, at General surgery department, Kafr El-Sheik University hospital, Egypt, during the period from December 2018 to December 2019. Group (A) was adopted the regular dressing postoperatively, while group (B) was treated with PRP injection into the wound at 4 and 12 postoperative days. Results Accelerated rate of wound healing was detected in group (B) in day 10, with a significant difference detected in days 15, 20, 25 and 30 postoperative, with a mean time of complete healing 45 ± 2.6 days in group B, while it was 57 ± 2.4 days in group A with a p-value of 0.001 which indicates considerable effect in the treated group. Conclusions PRP injection is an effective new technique in accelerating the healing of pilonidal wound after surgery, with a significant decrease in post-operative pain, complications and an early return to work. Trial registration retrospectively registered. Trial registration number: 12/35/1016 issued on December 2018 from the Institution Review Board at Kafr El Sheikh University. ClinicalTrials.gov identifier: NCT04430413

Download Full-text

Pilonidal Sinus Disease: Risk Factors for Postoperative Complications and Recurrence

International Surgery ◽

10.9738/cc86.1 ◽

2012 ◽

Vol 97 (3) ◽

pp. 224-229 ◽

Cited By ~ 29

Author(s):

Akin Onder ◽

Sadullah Girgin ◽

Murat Kapan ◽

Mehmet Toker ◽

Zulfu Arikanoglu ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Pilonidal Sinus ◽

Primary Closure ◽

Disease Risk ◽

Pilonidal Sinus Disease ◽

Limberg Flap ◽

Sinus Disease ◽

Faculty Department ◽

Closure Method

Abstract The aim of this study is to analyze the risk factors for complications and recurrence in pilonidal sinus disease. The prospective study consisted of 144 patients with pilonidal sinus disease who were operated on at Dicle University Medical Faculty, Department of General Surgery, between February 2008 and December 2010. Patients receiving the Limberg flap totaled 106 (73.6%), while 38 (26.4%) had primary closure. Postoperative complications developed in 42 subjects (29.2%), and recurrence occurred in 19 (13.2%). The Limberg flap method was statistically considered as a risk factor for postoperative complications (P = 0.039). Regarding recurrence, family tendency (P = 0.011), sinus number (P = 0.005), cavity diameter (P = 0.002), and primary closure (P = 0.001) were found to be risk factors. Postoperative complication rate is higher in the Limberg flap method than primary closure method. The risk of recurrence is related to family tendency, sinus number, cavity diameter and anesthesia type and is also higher in primary closure.

Download Full-text

Comparison of montelukast and mometasone furoate in the prevention of recurrent nasal polyps

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753465811427577 ◽

2011 ◽

Vol 6 (1) ◽

pp. 5-10 ◽

Cited By ~ 21

Author(s):

Erkan Vuralkan ◽

Cem Saka ◽

Istemihan Akin ◽

Sema Hucumenoglu ◽

Binnur Uzmez Unal ◽

...

Keyword(s):

Recurrence Rate ◽

Nasal Spray ◽

Peripheral Blood ◽

Nasal Polyposis ◽

Mometasone Furoate ◽

Significant Difference ◽

Before And After ◽

Group A ◽

Group B ◽

Snot 22

Background: The aim of our study was to compare the effects of montelukast and mometasone furoate nasal spray on the postoperative course of patients with nasal polyposis. Patients and methods: Fifty patients diagnosed with nasal polyposis between March 2006 and August 2007 were included in the study. All patients underwent bilateral endoscopic sphenoethmoidectomy and were randomized postoperatively into two groups. Group A ( n = 25) received 10 mg montelukast per day and group B ( n = 25) received 400 µg mometasone furoate nasal spray twice daily. All patients were followed up for 6 months. Sino-Nasal Outcome Test (SNOT)-22 scores, polyp grades, computerized tomography (CT) scores (Lund–Mackay), eosinophils in peripheral blood and polyp tissue were evaluated before and after surgery. Results: There was a significant reduction in SNOT-22 scores in both groups throughout the study period. There was a significant difference in the recurrence rate between both groups with a marginal advantage of mometasone furoate nasal spray. Eosinophils in peripheral blood were found to be effective on the recurrence rate ( p < 0.05). Conclusions: In conclusion, both drugs seem to have a complementary action and further studies are needed to determine which patients should receive which treatment.

Download Full-text

Excision and primary closure of pilonidal sinus disease: worthwhile option with an acceptable recurrence rate

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-010-0532-0 ◽

2010 ◽

Vol 180 (1) ◽

pp. 173-176 ◽

Cited By ~ 10

Author(s):

S. N. S. Gilani ◽

H. Furlong ◽

K. Reichardt ◽

A. O. Nasr ◽

G. Theophilou ◽

...

Keyword(s):

Recurrence Rate ◽

Pilonidal Sinus ◽

Primary Closure ◽

Pilonidal Sinus Disease ◽

Sinus Disease

Download Full-text

The Treatment of Wrist Ganglion Cyst by the Chinese Acupotomy and Crisscross Thread

10.21203/rs.3.rs-94895/v1 ◽

2020 ◽

Author(s):

Shuliang Zhang ◽

Bin Xu ◽

Yangjun Lao ◽

Di Lu

Keyword(s):

Recurrence Rate ◽

Ganglion Cyst ◽

Combined Treatment ◽

Vas Score ◽

Ganglion Cysts ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Cost ◽

Open Excision

Abstract Background: The current treatments of wrist ganglion have considerable recurrence rate, we developed a new treatment for ganglion cysts in our clinical practice, which combined acupotomy with crisscross thread method, so we now to compare the clinical effectiveness of Chinese acupotomy and crisscross thread with aspiration followed by injection of steroid and open excision for ganglion cysts treatment. Methods: Recruited patients with wrist ganglion were divided into three groups according to the treatments. Among them, 27 patients who were treated by a new combined treatment of Chinese acupotomy and crisscross thread method in group A, 30 patients who were treated by aspiration followed by steroid injection in group B, and 28 patients who were treated by open excision in group C. The data of age, gender, weight, size of ganglion cysts, visual analogue scale (VAS) , cost were recorded and compared by One-way analysis of variance, followed by an LSD (Least Significant Difference)test. The recurrence rates were recorded were analysed by chi-square test.Results: At the first day and one week after treatment, VAS score of group A was similar to group B with no statistic difference. VAS score of group C was higher than group A and B with statistic difference. Six months later, there was no statistic difference among the three groups about VAS. The recurrence rate was 3.7% in group A and 36.7% in group B and 10.7% in group C. No patient infected in three groups. The cost of group A was more than group B with no statistic difference. The cost of group A was much less than group C with statistic difference.Conclusions: The combination of Chinese acupotomy and crisscross thread method was a simple, economical and effective procedure for wrist ganglion cysts.

Download Full-text

Primary Closure Versus T-Tube Drainage Following Laparoscopic Common Bile Duct Exploration in Patients With Previous Biliary Surgery

The American Surgeon ◽

10.1177/0003134820947396 ◽

2020 ◽

pp. 000313482094739

Author(s):

Wan Zhen ◽

Wang Xu-Zhen ◽

Fu Nan-Tao ◽

Li Yong ◽

Xiao Wei-Dong ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Primary Closure ◽

Common Bile Duct Exploration ◽

Biliary Surgery ◽

Tube Drainage ◽

T Tube ◽

Significant Difference ◽

Group A ◽

Group B

Laparoscopic common bile duct exploration (LCBDE) has been recently introduced for management of CBD stone in patients with previous biliary surgery history. The aim of this study was to evaluate the safety and effectiveness of primary closure in patients with previous biliary surgery history compared to T-tube drainage. Eighty patients with previous biliary surgery history including laparoscopic cholecystectomy, open cholecystectomy, or open common bile duct exploration were enrolled in the retrospective study. The patients were divided into 2 groups according to the methods of choledochotomy closure. Group A: patients with primary closure after LCBDE (n = 51); group B: patients with T-tube drainage after LCBDE (n = 29). Group A exhibited a shorter postoperative hospital stay and lower hospitalization expenses compared to group B. There was no significant difference in conversion rate to open surgery, operating time, intraoperative blood loss, bile leakage rate, overall complication rate, and stone recurrence rate between the 2 groups. Biliary stricture was not observed in the 2 groups during the follow-up period. Primary closure following LCBDE is safe and effective for the management of CBD stones in patients with previous biliary surgery history.

Download Full-text